Provider Demographics
NPI:1396097937
Name:YOUBERG, WILLIAM MARK (LMHC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARK
Last Name:YOUBERG
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 201ST ST APT 7C
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2506
Mailing Address - Country:US
Mailing Address - Phone:718-225-5014
Mailing Address - Fax:
Practice Address - Street 1:4236 201ST ST APT 7C
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2506
Practice Address - Country:US
Practice Address - Phone:718-225-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001021-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health